May 6, 2005

The legislature is in its final week of the 2005 General Assembly. The budget has been finalized with a great deal of disagreement. Legislation is in a state of flux and changing daily.

Below is an update from this week’s activity.

 Legislature Sends Budget To Governor
A budget that increases public education funding by more than $100-Million but makes deep cuts to Medicaid and other state services has been sent to Governor Matt Blunt. The Legislature has completed the budget a day early and now prepares for the last week of the session. Democrats criticize the budget cuts as cruel. Republicans defend them as responsible. Republicans - the majority party in both the House and Senate - say they had no choice but to cut state services that they say have outgrown state revenue.

Senate Vote Recount Set for Jefferson County
Jefferson County election officials recount about 23,000 ballots in response to a challenge filed following the April 5th special election that saw Republican Bill Alter of High Ridge winning over three other candidates. Jeannie Goff, the County's Chief Deputy Elections Clerk, says the recount was triggered following a request from Democratic State Representative Rick Johnson of High Ridge, who lost by 68 votes. At issue are 191 so-called under-votes - ballots in which voters did not choose preferences in all the races being contested. Each of the 191 ballots showed no vote cast in the Senate race.

Senate Concurrent Resolution 19
SCR 19 is now scheduled for debate in the House.

SCR 19 establishes a Joint Interim Committee on a Missouri Health Care Stabilization Fund, with ten members, five from the House and five from the Senate, to encompass the following responsibilities:

1. Exploring the establishment of a Missouri Health Care Stabilization Fund to be administered by a health care stabilization board and housed within the Department of Insurance;
2. Investigating the primary objective of assuring health care providers that there will be reasonable medical malpractice liability coverage available within the state of Missouri;
3. Researching the possibility of requiring health care providers to carry primary medical malpractice coverage with another insurer in order to participate in the fund;
4. Investigating the feasability of the fund paying moneys to an aggrieved party if his or her damages exceed the health care provider's primary level of coverage;
5. Exploring any other ideas as necessary for possible implementation of the fund.

The committee shall expire on December 31, 2005, and on that same date, they shall deliver a report of their findings to the General Assembly.

Appropriations
As reported earlier the Senate chose to delete the Governor and House Recommendation to fund $875,000.00 for tobacco education/cessation efforts.

Committee members were contacted and sympathetic to the issue. Their attitude was to not fund a program at all if they could not fund it a level to have a significant impact.

It appears that the only was Missouri will get serious about a tobacco effort is through the initiative petition route.

Senate Undermines Bioterrorism Liability Measure
This week, the Senate debated a massive bill on county government issues that included a proposal developed by the St. Louis Area Regional Response System, an emergency preparedness consortium. Part of the proposal would authorize the State Legal Expense Fund to limit and insure the medical malpractice liability of health care providers who are deployed to provide treatment during a state-declared emergency. The fund currently provides liability coverage for the state and its employees, as well as a variety of medical and legal practitioners providing free or low-cost services. In the course of debating 39 amendments to House Bill 58, the Senate adopted by voice vote an amendment to delete the State Legal Expense Fund language. The amendment was developed by the Missouri Association of Trial Attorneys. The STARRS proposal still is pending in a Senate bill currently under review by the House of Representatives.

House Bill 85
As per communications with Ross McKinstry and Gil Copley, I visited with Representative Jack Jackson and he has included provisions of HB 85 in SB 420.

 HB 85 creates immunity from certain civil liabilities for health care professionals who are deployed to provide care during a state of emergency. It also requires the Department of Health and Senior Services and the Division of Professional Registration to release contact information and licensure or certification information relating to health care professionals to state, local, and private agencies to facilitate their deployment.

Committee Hears Lay Midwife Bill
Proponents of House Bill 36, a proposal to authorize the practice of lay midwifery, packed a hearing before the Senate Pensions, Veterans’ Affairs and General Laws Committee this week. Recently, the bill was narrowly passed by the House of Representatives. It has been amended to protect the authority of hospitals to control obstetrical practice within the facility and to protect doctors and hospitals from liability for providing emergency treatment of the patient of a lay midwife. The committee took no action on the bill.

Legislative Study Committees Advance
Two concurrent resolutions advanced this week. Concurrent resolutions are used to direct legislative actions such as creating legislative study commissions.

Senate Concurrent Resolution 19 was approved by a House committee and is ready for House floor debate. It authorizes the creation of a legislative Medicaid Reform Commission. Earlier this session, a new law was enacted to create a commission with the same membership and duties. However, the law will not go into effect until August 28, 2005 — the normal effective date for bills enacted in the 2005 session. The resolution would allow the commission to be formed immediately and work through the summer. Under the state law, the commission is to complete its recommendations for revamping the Medicaid program by January 1, 2006.

A Senate committee approved Senate Concurrent Resolution 15, which would create a legislative committee to study other states’ experiences with Health Care Stabilization Funds to provide medical malpractice liability insurance coverage. Legislation discussed during the 2005 legislative session would create a Missouri version of the Kansas Stabilization Fund. Under the proposals, all providers would be required to purchase coverage from the fund. The fund’s policies would provide a band of coverage for losses between $200,000 and $800,000 per claim. Private insurance would be used to cover losses less than or exceeding the program’s coverage limits.

Legislators Complete State Budget
The General Assembly has finished its enactment of the $19.2 billion state budget for the fiscal year beginning July 1. The appropriations bills now go to the governor, who has the authority to make line-item vetoes in the spending plan except funding for public schools and payments on public debt.

The following are key items in the Medicaid budget.

Medicaid coverage of the elderly and disabled will be provided to those with household incomes less than 85 percent of the federal poverty level. Currently, the income standard is 100 percent of the poverty level, which was reached in the current fiscal year after a three-year phased-in increase.

Currently, parents of Medicaid-eligible children can receive Medicaid coverage with household incomes less than 75 percent of the poverty level. In the new budget, the income limit will be set at 24 percent of the federal poverty level, which is the minimum allowed by federal law.

No change was made in income eligibility standard for children. The final budget includes a system of graduated premiums for Medicaid coverage of children under the State Children’s Health Insurance Program. The plan would impose a premium cap of 1 percent of household income for those with incomes between 151-185 percent of federal poverty, 3 percent of household income for those between 186-225 percent of federal poverty and 5 percent of household income for those with incomes between 226 and 300 percent of the poverty level. The Department of Social Services projects that no children would lose coverage under the graduated premium plan. A more restrictive premium plan earlier adopted by the House of Representatives was estimated by the department to result in about 23,000 children being dropped from SCHIP coverage.

The new budget eliminates Medicaid coverage for those in the Medical Assistance for the Working Disabled program, as well as recipients of General Relief.

Funding for various “rehabilitation and specialty services” in the Medicaid benefit plan will include oxygen and respiratory equipment, wheelchairs, ostomy supplies, emergency ambulance services, diabetes treatment supplies, hospice care, biennial eye exams and prosthetics. Services not funded would include outpatient rehabilitation services, eyeglasses, dental or podiatric treatment, day rehabilitation for head-injured adults, and wheelchair batteries and accessories. However, the full range of these services will be made available to children, pregnant women and the blind.

With some exemptions, Medicaid patients receiving physician care or hospital outpatient clinic or emergency room care will be responsible for a higher copayment. The current $2 copayment for outpatient hospital service is increased to $3.

Seat Belts
HB 518, 288, 418 and 635 is on the Senate formal calendar. This legislation contains primary seat belt enforcement and child safely restraint provisions.

County Health Centers
Senate Bill 258 was given final approval Wednesday. Currently, any county may operate a public health center. Whenever the county commission is presented with a petition signed by at least 10% of the voters asking that an annual tax be levied the county shall submit the question to the voters at an election.

In addition to the current method, this act would require the Cass County Commission and the Cooper County Commission to submit the question of establishing a public health center to the voters if the commission, by a majority vote, chooses to do so.

Next week
The legislature adjourns Friday, May 6 th at 6pm. I will continue to give you updates as the legislature progresses. There will be no final report on Friday as they will still be in session. I will provide a final wrap-up report during the week of the 16th for your review.

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